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Automatic Advantage enrollment causes confusion

Capital (Annapolis, MD)

Dear Savvy Senior, I'll be 65 in a few months and I recently pre-enrolled in original Medicare. But last week, I received a member card in the mail for a Medicare Advantage plan that I did not enroll in. What's going on?

Medicare is so confusing with all the different choices, and now it seems like I'm getting automatically enrolled in a plan I didn't even choose. Is this a scam? - New to Medicare

Dear New, It's not a scam, but it is a growing problem the Centers for Medicare and Medicaid Services needs to resolve. Here's what you should know.

When Americans first become eligible for Medicare - typically at age 65 - they can choose to enroll either in original Medicare, or they can opt for a Medicare Advantage plan, which is offered by private insurance companies. But some people, like yourself, are being enrolled in a Medicare Advantage plan without your knowledge.

Here's how it's happening.

Before becoming eligible for Medicare, many people are covered by a commercial or a Medicaid health care plan run by a private health insurance company. These insurers often operate Medicare Advantage plans, too.

Under a little-known rule authorized by the federal government, some insurers can shift their beneficiaries who are turning 65 to their own Medicare Advantage plan. It's a process called "seamless conversion enrollment," and all it requires is that the insurance company send a letter to the beneficiary explaining the new coverage, which takes effect unless the member opts out within 60 days.

The idea is to preserve continuity for those who want to stay with the same company. But some seniors are unaware that they've been signed up, in part due to the flood of mail they get around their 65th birthday from insurers marketing their Medicare plans. This makes it easy to miss a notice of seamless conversion or fail to understand the letter.

It can also have serious financial consequences. Medicare Advantage plans tend to be HMOs and PPOs with limited provider networks. If you unknowingly get enrolled in a Medicare Advantage plan and receive treatment from a doctor who's not in the network, your medical bills may go uncovered.

Consumer advocate groups like the Medicare Rights Center is pushing for a change in the rules. They want it set up so beneficiaries must respond to the letter/invitation before they're enrolled, versus having to opt out of automatic enrollment. In the meantime, here are some things you can do to protect yourself from unrequested Medicare enrollment.

Every one approaching age 65 should carefully read all mail received from your current health insurance provider. If you come across anything suggesting that the insurance company intends to enroll you in a Medicare Advantage plan that you do not wish to have, contact the insurer and decline to be enrolled.

Also, to be safe, about a month prior to Medicare eligibility, call your current insurer to confirm that you are not being automatically enrolled in a Medicare Advantage plan.

If you are enrolled in a Medicare Advantage plan against your wishes, call Medicare at 800-633-4227. People in this situation have been allowed to convert to traditional Medicare without having to wait until the next open enrollment period, or enroll in a different Medicare Advantage plan that they choose. It even might be possible to be retroactively enrolled in Medicare so out-of-network expenses already incurred are covered.

If you need help with your Medicare enrollment, contact your State Health Insurance Assistance Program, which provides free one-on-one Medicare counseling in person or over the phone. For contact information, visit www.shiptacenter.org or call the eldercare locator at 800-677-1116.